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  5. > Cardiac Surgical Robots: Market Shares, Strategies, and Forecasts, Worldwide, 2015-2021

The automated process revolution in surgery and communications is being implemented via robots. Robots automation of systems is providing significant improvement in the accuracy of surgery and the repeatability of process. Intuitive Surgical owns the market as the major participant with compelling market share in cardiac and lung surgical robots. This leadership position will need to be defended as other vendor products, now in clinical trials come to market. Advanced technology, an installed base and a well trained core group of surgeons give Intuitive Surgical market advantage. Patients for some types of procedures fare better when the heart or lung surgery is done by surgical robots. The documentation of improvements in care delivery, the ability to ensure better outcomes from surgery promise that cardiac and lung surgical robotics is a strong growth market. Heart disease is still the largest disease worldwide. The issue for cardiac and lung robotic surgery is that so many heart patients exist. Every leading surgeon working to perform heart and lung robotic surgery has worked to be accepted to practice at a hospital that has those robotic devices. The really talented surgeons depend on hospitals having the cardiac robotic equipment. In order to attract physicians and patients, the hospitals have to purchase the surgical equipment.

The market penetration of the cardiac and lung surgical robots will go to 100 percent in the US top hospitals within five years. As the surgeons migrate to the places that have the robotic surgical equipment, other hospitals and their potential patient populations notice. If the hospital does not have the surgical robotic equipment, it will not have any surgeons, this is a bad situation for a hospital. The cardiac and lung robotic surgical equipment permits better surgery and the surgeons and patients know this. Cardiac and lung robotic surgery is poised to eclipse open surgery. It is used in the categories of lobectomy, thoracic revascularization, and mitral valve repair surgery. Surgical robots are positioned to become the standard of care for hospitals in the delivery of some heart surgery. The emerging group of several surgical robotic companies will collectively have enough marketing dollars and enough marketing clout to drive replacement of virtually all open cardiac and lung surgery. Larger hospitals that can afford the expenditure are adopting heart and lung robotic surgical devices to improve their outcomes numbers. Hospitals are measured on outcomes, robots for surgery, when used by a trained physician are improving outcomes significantly. Hospital robotic systems have an emphasis on outcomes improvement during surgery. This has resulted in investment in robotics technology that is useful, and achieves positive patient outcomes.

Technology is enhancing a wide variety of procedures in many cardiac surgical specialties. Cardiac and thoracic surgeons at leading hospitals use robotic surgical systems increasingly. The aim is to perform more of the one-hundred thousand MIS surgical procedures of various types using robots. The surgeries performed by robot include cardiothoracic and vascular surgery. These surgical applications are cleared by the FDA. The technology uses metal tubes attached to the arms are inserted through the ports, and the cutting and visualization instruments are introduced through the tubes into the patient’s body. The surgeon performs the procedure while sitting at a console, manipulating the instrument controls and viewing the operation through a vision system. When a surgeon needs to change an instrument the instrument is withdrawn from the surgical field using the controls at the console and the nursing assistants switch instruments as per the physician instruction. This is done many times during an operation. The cardiac and lung surgical robot market is characterized enormous variety and innovation. A surgical robot recurring revenue business model is essentially a large one time purchase for a system complimented by replaceable or disposable instruments that cumulatively make the market a much larger and sustainable ongoing market. Vendors make money from the one time sale of a system and recurring revenue from sale of devices used in every operation.

Initially, a vendor sells and installs the surgical system into new customer accounts. Once systems are sold into customer accounts, the vendor generates recurring revenue as customers use the system to perform surgery. To do cardiac and lung robotic surgeries, the customers need to buy and consume instruments and accessory products. Vendors also generate recurring revenue from system service. According to Susan Eustis, lead author of the study, “Existing open cardiac and lung surgery can be replaced in some part by robotic surgery during the forecast period. Cardiac and lung robotic surgical approaches complement existing open surgery techniques. Soon, all surgery will be undertaken with at least come aspects of robotic surgery replacing or complementing open surgery.” The aging US population has supported demand, since the occurrence of health issues that require medical devices is higher in the elderly population. Buoyed by strong demand and sales, industry profit margins have increased considerably during the past five years. ospitals are adopting robotic surgical devices to improve their outcomes numbers. Hospitals are measured on outcomes, robots for surgery, when used by a trained physician are improving outcomes significantly. Hundreds of universities worldwide have research programs in robotics and many are awarding degrees in robotics. These “roboticists” are increasingly being hired by Global 2000 organizations to link mobile robots (mobile computers) into existing IT systems.

Robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. Surgeons no longer have to stand throughout the surgery and do not tire as quickly. Hand tremors are filtered out by the robot’s computer software. The surgical robot can continuously be used by rotating surgery teams. 3D viewing of the surgical site on a large screen improves visualization
of the surgical operating field. Cardiac and lung surgical robot device markets at $72.2 million in 2014 are anticipated to reach $2.2 billion by 2021 as next generation devices, systems, and instruments are introduced to manage surgery through small ports in the body instead of large open wounds. The complete report provides a comprehensive analysis including procedure numbers, units sold, market value, forecasts, as well as a detailed competitive market shares and analysis of major players’ success, challenges, and strategies in each segment and sub-segment. The reports cover markets for Cardiac and Lung robotic surgery medical specialties and sub-specialties.

Table Of Contents

Cardiac Surgical Robots: Market Shares, Strategies, and Forecasts, Worldwide, 2015-2021
Heart and Lung Surgical Robot Executive Summary 21
Heart and Lung Surgical Robot Market Driving Forces 21
Surgical Robotics Market Driving Forces 22
Cardiac Surgical Robot Key Procedures As Elements Of Strategy 24
Cardiac and Lung Surgical Robots Market Share Analysis 25
Cardiac and Lung Surgical Robot Market Forecasts 27
1. Cardiac Surgical Robot Market Description and Market
Dynamics 30
1.1 Cardiac Robotic Surgical Clinical Applications 30
1.1.1 Robotic Cardiothoracic Surgery 33
1.1.2 Mitral Valve Repairs Are Preferred Over Mitral Valve Replacement 33
1.1.3 Mitral Valve Repair 34
1.1.4 Mitral Valve Replacement Possible Complications 36
1.2 Interventional Cardiologists Treatments and Procedures 39
1.3 Robotic Internal Thoracic Artery Dissection 40
1.3.1 Robotic Thoracoscopy 41
1.3.2 Cardiothoracic Surgery 42
1.4 Surgical Robotic Lobectomy 42
1.5 Robotic Coronary Artery Bypass 43
2. Heart and Lung Surgical Robot Market Shares and
Market Forecasts 45
2.1 Heart and Lung Surgical Robot Market Driving Forces 45
2.1.1 Surgical Robotics Market Driving Forces 46
2.1.1 Cardiac Surgical Robot Key Procedures As Elements Of Strategy 49
2.2 Cardiac and Lung Surgical Robots Market Share Analysis 50
2.2.1 Intuitive Surgical da Vinciâ„¢ Surgical System Is Food and Drug
Administration (FDA) Approved Cardiac and Lung Robotic System 53
2.2.2 Corindus 54
2.2.3 MedRobotics 55
2.3 Cardiac and Lung Surgical Robot Market Forecasts 56
2.4 Cardiac and Lung Surgical Robot Installed Systems and Procedure Volumes
by Country 60
2.5 Key Players In The Global Medical Surgical Robots Market 66
2.6 Robotic Surgery Equipment Prices 66
2.1.2 Intuitive Surgical da Vinci Surgical System Prices 67
2.7 Cardiac and Lung Robotic Surgery Equipment Regional Market Segments 68
2.7.1 Intuitive Surgical Regional Revenue 71
2.7.2 Intuitive Surgical European Demand 72
2.7.3 Intuitive Surgical in Japan 72
2.7.4 U.S. Robotic Surgical Procedures 72
2.7.5 BRIC (Brazil, Russia, India, China) countries 73
2.7.6 Aging Taiwanese Population 73
2.7.7 Korea Focusing On Creating A Growth Engine In Research and
Development 74
2.7.8 Korea 74
2.7.9 Brazil 75
2.7.10 Chinese Imported Surgical Robots 75
2.7.11 Chinese Development of Surgical Robots 76
2.8 Chinese Robotic Cardiac Surgery 77
2.8.1 Chinese Robotic Cardiac Team Recognized As One Of World's Best 77
3. Cardiac Surgical Robots Product Descriptions 80
3.1 Intuitive Surgical Cardiothoracic Surgeries 80
3.1.1 Intuitive Surgical da Vinci Surgical System 82
3.1.2 Intuitive Surgical Da Vinci Minimally Invasive Surgical Product 83
3.1.3 Intuitive Surgical Cardiac Surgery 84
3.1.4 Intuitive Surgical da Vinci Surgical System Components 90
3.1.5 Intuitive Surgical Patient-Side Cart and Electromechanical Surgical
Arms 94
3.1.6 Intuitive Surgical 3-D Vision System 94
3.1.7 Intuitive Surgical Firefly Fluorescence Imaging 95
3.1.8 Intuitive Surgical. da Vinci Surgical System EndoWrist® Instruments 96
3.1.9 Intuitive Surgical Instruments and Accessories 98
3.1.10 Intuitive Surgical da Vinci Single-Site 99
3.1.11 Intuitive Surgical EndoWrist One Vessel Sealer 99
3.1.12 Intuitive Surgical da Vinci Skills Simulator 104
3.2 Titan Medical 105
3.3 Johnson and Johnson 109
3.3.1 Johnson and Johnson Ethicon 110
3.4 MedRobotics 112
3.4.1 Medrobotics Flex® Retractor 114
3.4.2 Medrobotics Flexible Robot Platform 115
3.4.3 Medrobotics Snakelike Robots for Oropharynx, Hypopharynx and
Larynx Surgery116
3.5 Corindus 119
3.5.1 CorPath Robotic Angioplasty 120
3.5.2 Corindus Command. Control CorPath® 200 System 121
3.5.3 Corindus Standard in Precision PCI 123
3.5.4 Robotic Angioplasty / Interventional Cardiology 127
3.6 Changzhou Kangxin Medical Instruments Co., Ltd. 128
3.7 Guangzhou Baitang Medical Instrument Co., Ltd. 128
4. Cardiac Surgical Robots Technology and Research 129
4.1 Intuitive Surgical Da Vinci Computerized Technology For Surgery 129
4.2 Intuitive Surgical da Vinci Xi Surgical System Minimally Invasive Surgery 130
4.2.1 Intuitive Surgical da Vinci Surgical System 131
4.3 Third Party Reimbursement 132
5. Cardiac and Lung Surgical Robots Company
Descriptions 135
5.1 Chinese Surgical Robots 135
5.2 Corindus 139
5.2.1 Corindus Benefits of CorPath Robotic-Assisted PCI 142
5.2.2 Corindus Improves Staff Position in the Room 143
5.3 Freehand 144
5.3.1 Freehand 2010 / Prosurgics 145
5.4 Intuitive Surgical 145
5.4.1 Intuitive Surgical Robotics da Vinci® Surgical System 151
5.4.2 Intuitive Surgical Robotics da Vinci Surgical System Xi 152
5.4.3 Intuitive Surgical Business Strategy 154
5.4.4 Intuitive Surgical Systems 157
5.4.5 Intuitive Surgical Patient Value As Equal To Procedure Efficacy /
Invasiveness 157
5.4.6 Intuitive Surgical Business Model 158
5.4.7 Intuitive Surgical Revenue 159
5.4.8 Intuitive Surgical Regulatory Activities 161
5.4.9 Intuitive Surgical Economic Environment. 161
5.5 Johnson and Johnson / DePuy Synthes 161
5.5.1 Google Collaborating With Johnson and Johnson To Develop Surgical
Robots 162
5.5.2 DePuy 162
5.5.3 Johnson and Johnson 163
5.5.4 Johnson and Johnson / Ethicon 163
5.6 Medrobotics 165
5.6.1 Medrobotics Closes On $10 Million Financing 167
5.6.2 Medrobotics Several Generations Of Snake Robot Platforms 168
5.6.3 Medrobotics Advances Clinical Development of Snake Robot for
Surgery 168
5.6.4 Medrobotics Positioning 168
5.6.5 Medrobotics Cardiac Surgery Gold Standard 169
5.6.6 Medrobotics Snake Robot Technologies For Use In A Wide Range Of
Surgical And Interventional Applications 170
5.6.7 Medrobotics Technology and Research Center 173
5.7 Medtronic 173
5.7.1 Medtronic PLC 175
5.7.2 Medtronic O-arm Surgical Imaging System 177
5.8 Meerecompany / Eterne 181
5.9 Titan Medical 182
5.9.2 Titan Medical General Surgery Robot Market Opportunities 188
5.9.3 Titan Medical Robotic Surgery Target Opportunity 189
5.10 TransEnterix Acquires the ALF-X Surgical Robotic System 191
5.10.2 TransEnterix Strategic Positioning 191
5.10.3 TransEnterix 193
5.10.4 TransEnterix / Sofar 193
5.11 Surgical Robot Companies 198
List of Tables and Figures
Table ES-1 26
Innovative Surgical Robot Features 26
Table ES-2 27
Surgical Robotics Market Driving Forces 27
Table ES-3 28
Surgical Robot Market Positioning 28
Table ES-4 30
Cardiac and Lung Surgical Robot Medical Sub-Specialties 30
Figure ES-5 31
Cardiac and Lung Surgical Robots Market Shares, Shipments, Dollars, Worldwide
2014 31
Figure ES-6 34
Cardiac and Lung Surgical Robot Systems Forecasts, Dollars, Worldwide, 2015-
2021 34
Table 1-1 35
Cardiac Conditions Requiring Surgery 35
Table 1-2 36
Intuitive Surgical Robotic Cardiac Procedures 36
Table 1-3 38
Robotic Surgery Surgical Specialty Focus 38
Table 1-4 40
Mitral Valve Problem Description 40
Table 1-5 41
Causes Of Mitral Valve Problems 41
Table 1-6 41
Mitral Valve Replacement Possible Complications 41
Table 1-7 42
Factors That May Increase The Risk Of Complications With Heart Surgery 42
Table 1-8 43
Physician-Patient Mitral Valve Heart Valve Assessment Program Aspects 43
Table 1-9 44
Catheter-Based Valve Disease Procedures 44
Table 1-10 45
Cardiac Surgeon Open Surgical Procedures: 45
Table 2-1 50
Innovative Surgical Robot Features 50
Table 2-2 52
Surgical Robotics Market Driving Forces 52
Table 2-3 53
Surgical Robot Market Positioning 53
Table 2-4 55
Cardiac and Lung Surgical Robot Medical Sub-Specialties 55
Figure 2-5 56
Cardiac and Lung Surgical Robots Market Shares, Shipments, Dollars, Worldwide
2014 56
Table 2-6 57
Cardiac and Lung Surgical Robot Market Shares, Dollars, Worldwide, 2014 57
Figure 2-7 63
Cardiac and Lung Surgical Robot Systems Forecasts, Dollars, Worldwide, 2015-
2021 63
Table 2-8 64
Heart and Lung Surgical Robot Market Segment Forecasts, Dollars and Units,
Worldwide, 2015-2021 64
Table 2-9 65
Number Intuitive Surgical Cardio/Thoracic Robotic Procedures, 65
Regional Analysis by Procedure Type, 2014 65
Table 2-10 66
Open and Robotic Surgeries: Cardio Thoracic Procedure Forecasts, Number US
and Worldwide, 2015-2021 66
Table 2-11 67
Table 2-11 (Continued) 68
Abdominal / Cardio Thoracic Robotic Surgery Procedures By Country, 2014 68
Table 2-12 69
Abdominal and Cardio Thoracic Robotic Surgery Procedures
By Country Installed
Procedures in Thousands % Systems %
US 11.2 70.0 73.9
Europe 1.9 11.9 22.3
Direct Sales
France 0.3 1.9 2.8
Germany 0.3 1.9 2.4
UK 0.3 1.9 1.7
Belgium 0.2 1.3 1.1
Switzerland 0.1 0.6 0.9
Sweden 0.0 0.0 0.8
Netherlands 0.0 0.0 0.6
Denmark 0.0 0.0 0.5
Norway 0.0 0.0 0.4
Chez Republic 0.0 0.0 0.2
Austria 0.0 0.0 0.2
Finland 0.0 0.0 2.4
Iceland 0.0 0.0 1.7
Other 0.0 0.0 0.1
Europe Sold By Distributors
Italy 0.2 1.3 2.7
Turkey 0.2 1.3 1.1
Spain 0.2 1.3 1.0
Russia 0.1 0.6 0.8
Greece 0.0 0.0 0.3
Romania 0.0 0.0 0.2
Other 0.0 0.0 0.4
add 1.9 11.9 6.4
Cardio Thoracic Robotic Surgery Procedure Forecasts, Lobectomy, Mitrial Valve
Repair, Vascular Surgery, Number of Procedures, Worldwide, 2015-2021 69
Figure 2-13 74
Cardiac and Lung Surgical Robot Regional Market Segments, Dollars, 2014 74
Figure 2-14 75
Cardiac and Lung Surgical Robot Regional Market Segments, 2014 75
Figure 2-15 82
China Robotic Cardiac Surgery 82
Figure 3-1 86
Intuitive Surgical Integrated Sub - Systems 86
Figure 3-2 87
Intuitive Surgical da Vinci Surgical System 87
Figure 3-3 88
Intuitive Surgical Da Vinci Surgery 88
Table 3-4 89
Intuitive Surgical Da Vinci Surgical System Components 89
Table 3-5 90
Intuitive Surgical Cardiac Conditions Addressed 90
Table 3-6 91
Minimally Invasive Da Vinci Surgery Benefits To Cardiac Patients 91
Figure 3-7 92
Intuitive Surgical da Vinci System State-Of-The-Art Robotic Surgical Platform 92
Table 3-8 92
Intuitive Surgical da Vinci Si Surgical System Core Benefits: 92
Figure 3-9 93
Intuitive Surgical da Vinci SI Surgical System Dual Console Used For Training And
Collaboration 93
Figure 3-10 94
Intuitive Surgical. da Vinci Surgical System Vision System 94
Table 3-11 96
Intuitive Surgical da Vinci Xi Surgical System Surgeon Console Features 96
Figure 3-12 97
Intuitive Surgical. da Vinci Surgical System Surgeon Console 97
Figure 3-13 98
Intuitive Surgical. da Vinci Surgical System Patient-Side Cart 98
Figure 3-14 101
Intuitive Surgical. da Vinci Surgical System EndoWrist® Instruments 101
Table 3-15 102
Intuitive Surgical da Vinci Surgical System Features 102
Table 3-16 105
Advantages of Intuitive Surgical Cardio Thoracic Robotic Surgery 105
Table 3-17 107
Surgical Robot Cardiothoracic Conditions Treated 107
Figure 3-18 107
Intuitive Surgical da Vinci Surgical System, Surgeon Operates Seated Comfortably
At A Console 107
Figure 3-19 108
Intuitive Surgical da Vinci Surgical System Patient Side Cart 108
Figure 3-20 110
Titan Single Port Orifice Robotic Technology SPORTâ„¢ Surgical System 110
Figure 3-21 111
Titan SPORTâ„¢ Surgical System: 111
Table 3-22 113
Titan MedicalSPORTâ„¢ Surgical System Patient Benefits: 113
Table 3-23 114
Titan MedicalSPORTâ„¢ Surgical System Surgeon Benefits: 114
Table 3-24 116
Johnson and Johnson Ethicon Minimally Invasive Procedures As They Apply To
Specific Conditions 116
Figure 3-25 119
Medrobotics Flex® Retractor 119
Figure 3-26 122
Medrobotics Snakelike Robot Tested for Heart Surgery 122
Table 3-27 123
Medrobotics Medical Field Target Markets 123
Figure 3-28 125
Corindus CorPath Robotic Angioplasty 125
Figure 3-29 127
Corindus Command. Control CorPath® 200 System 127
Figure 3-30 128
Corindus Precise Robotic Movement And Device Fixation 128
Table 3-31 129
Corindus Robotic-Assisted Control Benefits 129
Figure 3-32 130
Occupational Hazards in Cath Lab 130
Figure 3-33 131
Corindus Robotic Assisted PCI 131
Figure 4-1 136
Intuitive Surgical da Vinci Surgical System 136
Figure 5-1 141
Tianjin Municipality Micro Hand A Chinese Surgical Robots 141
Figure 5-2 143
China's First Surgical Robot For Minimally Invasive Surgery At Tianjin
Municipality 143
Table 5-3 145
Benefits of Corindus CorPath Robotic-Assisted PCI 145
Figure 5-4 146
Corindus CorPath Benefits 146
Table 5-5 147
Corindus Benefits of CorPath Robotic-Assisted PCI 147
Figure 5-6 148
Corindus Step Away From Radiation Source During Robotic PCI 148
Table 5-7 149
Corindus CorPath Robotic-Assisted PCI Mean Radiation Dose (per procedure) By
Position (?SV)2 149
Figure 5-8 157
Intuitive Surgical Platform, daVinci Xi 157
Table 5-9 160
Intuitive Surgical Strategy To Improve Candidate Surgical Procedures 160
Table 5-10 166
Johnson and Johnson Family of Companies Comprises: 166
Table 5-11 170
Medrobotics Positioning 2015 170
Table 5-12 175
Medrobotics Cardiac Surgery Improvements 175
Table 5-12 176
Medrobotics Snake Robot Technologies For Use In A Wide Range Of Surgical And
Interventional Applications 176
Table 5-13 177
Medrobotics Snake Robot Technologies Specialist Areas Served 177
Table 5-14 180
Medtronic O-arm® Surgical Imaging StealthStation® Navigation Functions 180
Table 5-15 181
Medtronic O-arm Surgical Imaging System Benefits 181
Table 5-16 183
Medtronic O-arm Surgical Imaging System 183
Table 5-17 184
Medtronic O-arm Surgical Imaging System Benefits 184
Figure 5-18 185
Medtronic Lumbar Imaging 185
Table 5-19 188
Titan Medical Investment Summary 188
Figure 5-20 189
Titan Medical Business Goals and Timetable 189
Figure 5-21 193
Titan Medical Describes Robotic General Surgery Market Potential 193
Figure 5-22 195
Titan Medical Robotic Surgery Target Opportunity 195
Table 5-23 197
TransEnterix Strategic Positioning 197
Figure 5-24 199
TELELAP Robotic Surgical Unit 199
Figure 5-25 201
Telelap ALF-X Robotic Surgery 201
Figure 5-26 202
TELELAP ALF-X Breaking Barriers Supporting Precision 202

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